Provider Demographics
NPI:1093295966
Name:BALDWIN, WENDY (BCBA LBA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10174 SENTINEL LOOP
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5102
Mailing Address - Country:US
Mailing Address - Phone:253-232-8207
Mailing Address - Fax:
Practice Address - Street 1:10174 SENTINEL LOOP
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5102
Practice Address - Country:US
Practice Address - Phone:253-232-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA60887376103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA60887376Medicaid